Does Acupuncture Work?

In the New Zealand Listener of October 13 2012, Health writer, Margo White, published an article entitled "Getting to the Point". On line the same article was entitled "Does Acupuncture Work?" Regardless of which title used, the article did not paint our profession in a particularly good light. Several NZRA members responded.

Most weeks I enjoy reading Margo White’s Health article. Not so this week. Her article “Getting to the Point” was very disappointing and I was left wondering as to what her point actually was. Acupuncture trials in the 1970’s and 80’s in the Western world may well have been poorly designed but the world has moved on dramatically in the last 30-40 years.

Instead of choosing to write about dubious research involving a mouse, Margo would have served us better to have shared those studies which show via functional magnetic resonance imaging (fMRI) that there is unequivocal evidence that acupuncture has a clearly demonstrable effect on the body. Or she could have included the increasing numbers of well-designed studies that show that acupuncture has a very positive effect in the treatment of infertility or osteo-arthritis.

I recently returned from speaking at a conference in Seoul, Korea which was entitled “The Future of Medicine – Traditional Medicine”. The more than 16,000 delegates from throughout the world were under no illusion that acupuncture “works”. Traditional Korean medicine (which like Traditional Chinese Medicine incorporates both acupuncture and herbal medicine) holds equal status with western medicine within Korean hospitals. There are 11 universities of traditional medicine in Korea and they turn out between 7000 and 8000 graduates every year.

Acupuncture is extensively used throughout the Asian nations and is growing in popularity throughout the west. National registration of the profession began in Australia in July this year, putting acupuncturists and other Chinese medical practitioners on equal footing with other health professionals. Here in New Zealand acupuncture students graduate with a New Zealand Qualifications Authority recognised Bachelor degree and members of the New Zealand Register of Acupuncturists have been recognised as ACC Treatment Providers since 1990. Recognition under the Health Practitioners Competence Assurance Act is on the horizon.

A little more research would have better served Margo and her readers. Acupuncture is here to stay.

2. From Debra Betts and Mike Armour - PhD Candidates with the University of Western Sydney

It is interesting to note that research concluding “Acupuncture is effective for the treatment of chronic pain…Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However these differences are relatively modest ” is only reported as the “ differences between sham acupuncture and acupuncture were relatively modest .” ( “ Getting to the point ,” October 13).

If this was a trial using ultrasound therapy would only the “ relatively modest ” comment from this conclusion have been reported? Margo White appears to rely on the opinion of Edzard Ernst. Within the diversity of acupuncture research this may be the equivalent of a government official taking one person’s word that Kim Dotom is not a New Zealand citizen. A common refrain in many review articles or scientific papers is that ‘more are studies needed’. This is not confined to acupuncture studies, but also to many non-pharmacological therapies such as physiotherapy.

As PhD candidates currently involved in acupuncture research, we are also wondering why a discussion on a mouse model was used in this article. Mice are, unfortunately, not little furry humans and while this research may be interesting to some scientists, it doesn’t bear any reflection on actual clinical practice. It is also concerning that the author has a “quick search” but doesn’t examine any of the many Cochrane reviews (the gold standard of medical reviews) on acupuncture that discuss research on humans in more clinically relevant settings. Perhaps the readers of this column would appreciate an unbiased discussion of the current research concerning acupuncture?

3. From John Black- Practitioner, Nelson

Acupuncture was discovered, not invented. It was not created by someone, based on a theory or understanding of the body. It was developed through a process of discovery, observation and experimentation over millennia. Through repeated observations, Traditional Chinese doctors came up with theories of meridians and qi. These were not an attempt to satisfy curiosity as to how acupuncture worked, they were creating a practical working model for the practitioner to use, and combined with complex theories of health, disease and diagnosis, refined and developed over many years, the Traditional Chinese Medical (TCM) practitioner has a powerful toolbox with which to treat disease.

An essential component of TCM, whether acupuncture or herbal medicine, is that it is individualised, absolutely not a one shoe fits all approach. The properly trained practitioner will ask a number of questions before determining which combination of acupoints or herbs should be prescribed for the condition. In the case of acupuncture, a key component is also the way in which the needles are inserted and stimulated.

Along come western medical doctors who have typically done a few weekend courses in acupuncture, with virtually zero training in needling technique, carrying out double blind research by needling exactly the same points (looked up in a textbook) in half the patients without proper stimulation of the needles, and do sham points in the other half. Unsurprisingly, they find only minor differences between the two groups. Individualised treatment, as done by TCM practitioners is the key to effective treatment, yet this is dismissed as unscientific by the likes of Simon Singh.

Do we conclude that physiotherapy is unscientific because it is not double blind tested? Western medicine discovered about 160 years ago that iodine treatment could reverse goitre. TCM doctors were prescribing kelp seaweed (iodine rich) for goitre 3000 years ago. Did this become scientific only 160 years ago? Many of the conditions treated by acupuncturists are objectively evaluated by blood tests, notably, fertility and thyroid issues. Clearly acupuncture works on the nervous system, and blood tests frequently demonstrate hormonal changes taking place with acupuncture. Given that the two major regulatory systems of the body are the nervous and endocrine systems, it is hardly baffling that acupuncture works.

As for the exact mechanisms, there are many prescription medications in use with proven efficacy but whose mechanisms are unknown. Why don't we dismiss their use as quackery? Neurologists don't understand the exact mechanisms by which the brain works. We should therefore conclude that it doesn't work!

Thanks to those others who also replied - it will be interesting to see if any of our responses are published.